Risk of alcohol use relapse after liver transplantation for alcoholic liver disease

Table 1 Psychosocial evaluation criteria of liver transplantation for alcoholic liver disease

Criteria A

Abstinence period lasting at least 6 mo

An oath of the abstinence from alcoholic drinking for the future

Patients with alcoholic liver disease are needed to fulfill the criteria A.

Criteria B

No presence of psychiatric comorbidity except alcohol-related mental disease

A dherence of medical treatment

Understanding and agreement of transplant and a support by the family

Being at work or ready to work

The high-risk alcoholism relapse scale can be scored 0, 1, or 2

Criteria C

Re-evaluation one month later in case who is difficult to evaluate risk of alcohol use relapse in the initial interview

Table 2 Sociodemographic and clinical characteristics of 67 alcoholic liver disease patients

	Mean	Range or standard deviation			No./No. responded	Percentage
Age1 (yr)	50.2	28-69	Adherence of medical treatment	Present	45/67	67
Gender2 (male/female)	48/19			Absent	20/67	30
Hepatic encephalopathy2 (point)	1.2	0.4		Unknown	2/67	3
Ascites2 (point)	2.0	0.8	Being at work or ready to work	Present	47/67	70
Bilirubin2 (mg/dL)	6.1	6.0		Absent	18/67	27
Albumin2 (g/dL)	2.8	0.5		Unknown	2/67	3
International normalized ratio of prothrombin time2	1.83	0.7	Understanding and agreement of transplant and a support by the family	Present	61/67	91
Creatinine2 (mg/dL)	0.9	0.6		Absent	6/67	9
Model for end-stage liver disease score2 (point)	1.9	7.0	Presence of psychiatric comorbidity except alcohol-related mental disease	Present	2/67	3
Child-Pugh score2 (point)	10.1	2.0		Absent	65/67	97
Duration of heavy drinking2 (yr)	21.7	10.4	Declaration of abstinence	Present	55/67	82
Usual number of daily drinks2 (L)	2.1	0.8		Absent	12/67	18
The HRAR scale2 (point)	2.3	1.0	Psychiatric hospitalizations	Present	1/67	1
Prothrombin time2 (%)	34.3	16.4		Absent	66/67	99
Abstinence period2 (mo)	12.1	15.8

¹Result was shown as mean and range;

²Results were shown as mean and SD. HRAR: High-Risk Alcoholism Relapse.

Table 3 The characteristics of 7 patients with decompensated liver cirrhosis due to alcoholic liver disease who underwent liver transplantations

Case	Age at the first drinking	Age at the first examination	Age at the LT	Gender	Comorbidity	Daily intake of alcohol1	LT	Follow-up (yr)	Alcohol relapse	Self-help groups
1	24	32	36	Male	None	17.6	Deceased-donor	8.3	None	None
2	27	38	38	Female	None	6.5	Deceased-donor	9.9	None	None
3	15	42	44	Male	Non-BNon-CLiver cirrhosis	16.0	Deceased-donor	7.3	None	Participation (spouse only)
4	17	44	46	Male	Liver cirrhosis (type C)	20.0	Deceased-donor	4.8	Relapse2 (3 yr after)	None
5	13	28	28	Male	None	20.0	Living-donor (relation: father)	3.3	None	Participation
6	17	51	51	Female	Liver cirrhosis (type C)Hepatocellular carcinoma	15.0	Living-donor (relation: daughter)	1.3	None	None
7	9	46	46	Female	None	20.0	Living-donor (relation: younger brother)	0.5	None	None

¹The unit of a standard drink in Japan contained 10 g of alcohol;

²The patient quit alcohol with the immediate psychiatric intervention (psychoeducation and supportive psychotherapy) by psychiatrists.

Table 4 Statistical results

	T/R group (n = 17)	Non-T/R group (n = 50)	t-statistic	Degree of freedom	Statistical significance			T/R group (n = 17)		Non-T/R group (n = 50)		Statistical significance
	Mean (range or SD)	Mean (range or SD)						No/no responded (percentage)		No/no responded (percentage)
Age1 (yr)	45.5 (28-62)	51.8 (31-69)				Adherence of medical treatment	Present	17/17	(100)	28/50	(56)	P < 0.01
Gender (male/female)	11/6	37/13					Absent	0/17	(0)	20/50	(40)
Abstinence period2 (mo)	21.2 (17.4)	8.8 (13.6)	2.84	59	P < 0.01		Unknown	0/17	(0)	2/50	(4)
Amount of drinking2 (point)	2.3 (0.7)	2.1 (0.8)	1.14	58	NS	Being at work or ready to work	Present	15/17	(88)	32/50	(64)	NS
Duration of heavy drinking2 (yr)	16.4 (7.5)	23.8 (10.5)	2.62	58	P < 0.05		Absent	2/17	(12)	16/50	(32)
							Unknown	0/17	(0)	2/50	(4)
						Understanding and agreement of transplant and a support by the family	Present	16/17	(94)	45/50	(90)	NS
							Absent	1/17	(6)	5/50	(10)
						Presence of psychiatric comorbidity except alcohol-related mental disease	Present	0/17	(0)	2/50	(4)	NS
							Absent	17/17	(100)	48/50	(96)
						Declaration of abstinence	Present	17/17	(100)	38/50	(76)	P < 0.05
							Absent	0/17	(0)	12/50	(24)
						Psychiatric hospitalizations	Present	1/67	(6)	0/50	(0)	NS
							Absent	16/67	(94)	50/50	(100)

¹Results were shown as mean and range;

²Results were shown as mean and SD.